title: High-dose chemotherapy followed by autologous stem cell transplantation for metastatic rhabdomyosarcoma--a systematic review.
abstract: BACKGROUND
  Patients with metastatic rhabdomyosarcoma (RMS) have a poor prognosis. The aim of this systematic review is to investigate whether high-dose chemotherapy (HDCT) followed by autologous hematopoietic stem cell transplantation (HSCT) in patients with metastatic RMS has additional benefit or harm compared to standard chemotherapy.
  
  
  METHODS
  Systematic literature searches were performed in MEDLINE, EMBASE, and The Cochrane Library. All databases were searched from inception to February 2010. PubMed was searched in June 2010 for a last update. In addition to randomized and non-randomized controlled trials, case series and case reports were included to complement results from scant data. The primary outcome was overall survival. A meta-analysis was performed using the hazard ratio as primary effect measure, which was estimated from Cox proportional hazard models or from summary statistics of Kaplan Meier product-limit estimations.
  
  
  RESULTS
  A total of 40 studies with 287 transplant patients with metastatic RMS (age range 0 to 32 years) were included in the assessment. We identified 3 non-randomized controlled trials. The 3-year overall survival ranged from 22% to 53% in the transplant groups vs. 18% to 55% in the control groups. Meta-analysis on overall survival in controlled trials showed no difference between treatments. Result of meta-analysis of pooled individual survival data of case series and case reports, and results from uncontrolled studies with aggregate data were in the range of those from controlled data. The risk of bias was high in all studies due to methodological flaws.
  
  
  CONCLUSIONS
  HDCT followed by autologous HSCT in patients with RMS remains an experimental treatment. At present, it does not appear justifiable to use this treatment except in appropriately designed controlled trials.
authors.affiliation: Institute for Quality and Efficiency in Health Care (IQWiG), Cologne, Germany. frank.peinemann@iqwig.de
authors.forename: Frank
authors.initials: F
authors.lastname: Peinemann
authors.forename: Nicolaus
authors.initials: N
authors.lastname: Kröger
authors.forename: Carmen
authors.initials: C
authors.lastname: Bartel
authors.forename: Ulrich
authors.initials: U
authors.lastname: Grouven
authors.forename: Max
authors.initials: M
authors.lastname: Pittler
authors.forename: Rudolf
authors.initials: R
authors.lastname: Erttmann
authors.forename: Michael
authors.initials: M
authors.lastname: Kulig
mesh_terms: D000293:Adolescent; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage*; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D004305:Dose-Response Relationship, Drug; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D009362:Neoplasm Metastasis; D011379:Prognosis; D012208:Rhabdomyosarcoma / Q000175:diagnosis / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D014182:Transplantation, Autologous; D016896:Treatment Outcome; D055815:Young Adult